Provider Demographics
NPI:1043839939
Name:BENAVIDEZ, KIMBERLY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:BENAVIDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MSC (10-5550)
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO DEPT. OF INTERNAL MEDICINE
Mailing Address - City:ALBUQERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-6331
Mailing Address - Fax:
Practice Address - Street 1:MSC (10-5550)
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO DEPT. OF INTERNAL MEDICINE
Practice Address - City:ALBUQERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program